Implementation of a Postdischarge Virtual Visit and Nurse Follow-up Protocol to Decrease 30-Day Readmission Rates for Patients with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a rare, chronic disease with no cure. Patients with this disease have high mortality and morbidity, experience frequent hospitalizations, readmissions, and psychosocial burdens, and require a high degree of self-care management skills (Doyle-Cox et al., 2016; Lattimer et al., 2016; McDevitt & Walter, 2019). More than half of PAH patients are hospitalized within the first year following diagnosis, and about 20% are readmitted to the hospital within thirty days of discharge (Bhattacharya et al., 2019: Tonelli, 2020). These patients also have a high symptom burden, and these symptoms significantly affect their physical and mental quality of life (Matura et al., 2016). As the disease progresses, so do the symptoms, leading to an increased need for symptom monitoring and management by the patient and the healthcare team. The Pulmonary Arterial Hypertension Center of Comprehensive Care is an accredited facility that serves approximately 400 PAH patients residing in the gulf south region. Evidence supports a multidisciplinary, multi-pronged, comprehensive care model approach to PAH patients\u27 care as they transition through various settings. This quality improvement project introduces two telehealth interventions to address the critical care needs of this population. The first intervention was a provider-led postdischarge follow-up virtual visit that occurred one week after hospitalization. The second was scheduled nurse-led telephone calls beginning after hospital discharge. These interventions were designed to reduce hospital readmissions for this population, encourage self-care management, and remove barriers to quality healthcare by combining technology with best practice healthcare

Participation in a Traditional Mentorship Program: A Multiple Case Study of Alternatively Certified Teachers

The purpose of this multiple case study was to understand the impact of a traditional mentorship program on 13 alternatively certified teachers in a suburban school district in the southeastern part of the state of Virginia. This research utilized a qualitative multiple case study design. Guiding this qualitative study were Knowles’ adult and Mezirow’s transformative learning theories. Knowles’ (1970) theory projects the idea of using experiential learning to construct one’s own meanings, while Mezirow’s (1995) theory advances the idea of humans constructing new ideas and meanings based on new perspectives. The central research question guiding this study was: How did participation in a traditional teacher mentorship program in a suburban school district in the southeastern part of the state of Virginia impact alternatively certified teachers’ success? Thirteen alternatively certified teachers who participated in a traditional teacher mentorship program during their first year in the profession were chosen through purposeful criterion sampling. Data collection included document analysis/archival records, field notes/observations, and teacher interviews. Preliminary analysis, coding, cross-case synthesis, and naturalistic generalizations were used for data analysis

The influence of dietary polyunsaturated fatty acids on the immune response of Atlantic salmon (Salmo salar L.)

The present work examined the effects of dietary (n-3)/(n-6) PUFA ratios in Atlantic salmon parr on, firstly, the fatty acid composition of lipids in peripheral blood cells and immunocompetent tissues and secondly, disease resistance. No notable differences in physiological and immunological parameters were observed between fish fed different (n-3)/(n-6) PUFA diets, except for a significantly higher number of responding B cells in kidney and spleen of the fish fed high (n-3)/(n-6) PUFA diet. The protective vaccination of the groups of fish on the different (n-3)/(n-6) PUFA ratio diets was inconclusive, but significantly more salmon died in the low (n-3)/(n-6) group when non-vaccinated fish were challenged with Vibrio anguillarum. Lipid class composition of lipids from leucocytes, erythrocytes and .serum were all found to be independent of diet, while component fatty acids were definitely influenced by dietary PUFA. Total fatty acids of the erythrocyte lipid were always high in (n-3) PUFA. Leucocyte lipid, by comparison, contained higher levels of saturated and monocnoic fatty acids, particularly 18:1 (n-9). The overall (n-6) PUFA unsaturation was higher in the lipid of leucocytes than the erythrocytes and leucocytes incorporated greater proportions of dietary 18:2(n-6) into their lipid than erythrocytes. Levels of 18:2(n-6) in the lipid of .serum and leucocytes from (n-6) PUFA fed fish began to rise after four weeks on the diet, and increased steadily until a (n-3)/(n-6) PUFA ratio of 0.8 was maintained after 16 weeks. Erythrocytes did not show diet induced modification until 8-16 weeks, at which point 18;2(n-6) fatty acid levels were observed to plateau. Influences of dietary fatty acid composition were most evident in the PC and PE fractions. Dietary 18:2(n-6) fatty acid incorporation was greater in the lipids of the lymphoid organ tissues than in leucocytes isolated from these tissues. Lymphoid tissues from (n-3) dietary group fish possessed higher (n-3)/(n-6) PUFA ratios than their leucocytes, while (n-3)/(n-6) PUFA ratios were found to be similar between the lymphoid tissues and their corresponding leucocytes of the (n-6) PUFA dietary group. Lipid from headkidney macrophages of Atlantic salmon was higher in phospholipids than headkidney leucocytes and T and B-cells, while their fatty acid profiles were similar. Comparisons of salmon parr were made with a warm water species of fish and a mammalian species. The fatty acid composition of rabbit cell lipid reflected their dietary 18:2(n-6) intake, whereas the fish had high levels of (n-3) PUFA. Erythrocytes and leucocytes of African catfish had similar fatty acid compositions, while Atlantic salmon erythrocytes contained a higher degree of 22:6(n-3) fatty acid than did the leucocytes. T3ic leucocyte lipid of salmon contained higher levels of saturated and monoenoic fatty acids than the catfish leucocytes. The lipid class and fatty acid composition of Atlantic salmon erythrocytes and leucocytes were unaffected by water temperature, except for a higher PE level in the erythrocytes of cold water acclimated fish. When salmon leucocytes were cultured in vino, the lipid composition of the leucocytes was unaffected by FCS or fish serum when these were used as medium supplements. The rate of incoiporation of exogenous fatty acids into the peripheral blood leucocytes was influenced by metabolic temperature. Greatest incorporation of exogenous fatty acids by fish peripheral blood leucocytes occurred within the first day of incubation, but peaked around day 2 when cells were cultured at 15 C, and day 5 when incubated at 4°C. Kidney and blood leucocytes incorporated greater amounts of 20:4(n-6) and 18:l(n-9) fatty acid into their lipid than those from thymus and spleen, but all leucocytes displayed a preference for 20:4(n-6) and 18:l(n-9) fatty acids over 20:S(n-S), 18:2(n-6) and 18:3(n-3). The study suggests that the lymphoid system of salmon is predisposed to (n-6) PUFA despite the natural abundance of (n-3) PUFA in the lipids of salmon diets and tissues

A Genetic Analysis of Variation for the Ability to Fly After Exposure toThermal Stress in Drosophila mojavensis

To help us understand how adaptive tolerance to heat stress has evolved, we made F1 hybrid crosses and backcrosses amongst populations of Drosophila mojavensis, and tested their ability to fly after exposure to a debilitating, but non-lethal, heat stress. Previous work identified that these populations vary in thermotolerance as measured for a variety of traits. Hybrid superiority was observed when crossing all four pairs of strains. Patterns of inheritance in flight ability after stress varied depending on which strains were used to set up complete reciprocal backcrosses, and, for both population pairs, results supported a multigenic model. This quantitative inheritance may be an outcome of the many different physiological and biochemical systems recently shown to influence muscle activity during heat stress. Therefore, the ability to maintain flight in the presence of high temperatures has the potential to vary considerably among populations in nature. As effects occur at temperatures well below those causing mortality, variation in this trait may greatly impact organismal fitness

Direct and Correlated Effects of Selection on Flight After Exposure to Thermal Stress in Drosophila melanogaster

To demonstrate how insects may adapt to ecologically relevant levels of heat stress, we performed artificial selection on the ability of Drosophila melanogaster to fly after an exposure to a high but non-lethal thermal stress. Both tolerance and intolerance to heat stress arose very quickly, as only a few generations of selection were necessary to cause significant separation between high and low lines for heat tolerance. Estimates of heritability based on the lines artificially selected for increased flight ability ranged from 0.024 to 0.052, while estimates of heritability based on the lines selected for the inability to fly after heat stress varied between 0.035 and 0.091. Reciprocal F1 crosses among these lines revealed strong additive effects of one or more autosomes and a weaker X-chromosome effect. This variation apparently affected flight specifically; neither survival to a more extreme stress nor knockdown by high temperature changed between lines selected for high and low heat tolerance as measured by flight ability. As the well-studied heat-shock response is associated with heat tolerance as measured by survival and knockdown, the aspects of the stress physiology that actually affect flight ability remains unknown

eNpHR: a Natronomonas halorhodopsin enhanced for optogenetic applications

Temporally precise inhibition of distinct cell types in the intact nervous system has been enabled by the microbial halorhodopsin NpHR, a fast light-activated electrogenic Cl^− pump. While neurons can be optically hyperpolarized and inhibited from firing action potentials at moderate NpHR expression levels, we have encountered challenges with pushing expression to extremely high levels, including apparent intracellular accumulations. We therefore sought to molecularly engineer NpHR to achieve strong expression without these cellular side effects. We found that high expression correlated with endoplasmic reticulum (ER) accumulation, and that under these conditions NpHR colocalized with ER proteins containing the KDEL ER retention sequence. We screened a number of different putative modulators of membrane trafficking and identified a combination of two motifs, an N-terminal signal peptide and a C-terminal ER export sequence, that markedly promoted membrane localization and ER export defined by confocal microscopy and whole-cell patch clamp. The modified NpHR displayed increased peak photocurrent in the absence of aggregations or toxicity, and potent optical inhibition was observed not only in vitro but also in vivo with thalamic single-unit recording. The new enhanced NpHR (eNpHR) allows safe, high-level expression in mammalian neurons, without toxicity and with augmented inhibitory function, in vitro and in vivo

Comparative evaluation of Polymerase Chain Reaction - Restriction Enzyme Analysis (PRA) and Sequencing of Heat shock protein 65 (hsp65) gene for identification of aquatic mycobacteria

Traditional identification of mycobacteria based on cultural and biochemical tests can take several weeks and may fail to provide a precise identification. Polymerase Chain Reaction-restriction analysis (PRA) of the gene encoding heat shock protein 65kDA (hsp65) gene has been proposed as a rapid and inexpensive alternative approach. Despite being widely used for differentiation of mammalian mycobacteria, this method has only been applied in the identification of a small number of aquatic mycobacteria. The present study aimed to evaluate the potential use of PRA of hsp65 for the identification of aquatic mycobacteria compared with sequence analysis. Seventy one mycobaterial isolates including, 10 type/reference strains and the remainder field isolates, were subjected to PRA of a 441 bp fragment of this gene. For 68 representative isolates, sequence analysis was performed. All rapidly and slow growing mycobacteria had best matches with 99.3% to 100% similarity with their corresponding species in the databanks. PRA proved to be a simple and rapid method for identifying aquatic mycobacteria. However, the incidence of similar or identical restriction patterns for some species of mycobacteria, and in particular, identification of new species of mycobacteria is a major problem using such a method. In contrast, the nucleic acid sequencing of the hsp65 gene yielded unambiguous results

Small Business Sustainability: What is the CPA’s Role?

The purpose of this paper is to provide information for both small businesses and CPAs concerning the importance and possible impact of sustainability reporting and practices on each group. The sustainability reporting process not only considers the economic bottom line, but also includes consideration of how a business impacts society and the environment. The challenges involved in establishing sustainable practices and reporting will be significant. The push for businesses to become more sustainable is a market-driven phenomenon in which consumers are increasingly shopping for products and services provided by companies that practice sustainability. Large multinational corporations are placing greater pressure on small business supply chain vendors to adopt sustainability practices. The sustainability movement creates both threats and opportunities for both LMCs and SMEs, and businesses that fail to develop sustainable strategies could be negatively impacted. CPAs have traditionally provided SMEs with financial, tax and audit services. As sustainability demands increase for SMEs, small and medium-sized CPA firms must develop the knowledge and skills necessary to provide these clients with sustainability services